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Heat stroke in athletes is entirely preventable. Exertional heat illness is generally the result of increased heat production and impaired dissipation of heat. It should be treated aggressively to avoid life-threatening complications. The continuum of heat illness includes mild disease (heat edema, heat rash, heat cramps, heat syncope), heat exhaustion, and the most severe form, potentially life-threatening heat stroke. Heat exhaustion typically presents with dizziness, malaise, nausea, and vomiting, or excessive fatigue with accompanying mild temperature elevations. The condition can progress to heat stroke without treatment. Heat stroke is the most severe form of heat illness and is characterized by core temperature >104 degrees F with mental status changes. Recognition of an athlete with heat illness in its early stages and initiation of treatment will prevent morbidity and mortality from heat stroke. Risk factors for heat illness include dehydration, obesity, concurrent febrile illness, alcohol consumption, extremes of age, sickle cell trait, and supplement use. Proper education of coaches and athletes, identification of high-risk athletes, concentration on preventative hydration, acclimatization techniques, and appropriate monitoring of athletes for heat-related events are important ways to prevent heat stroke. Treatment of heat illness focuses on rapid cooling. Heat illness is commonly seen by sideline medical staff, especially during the late spring and summer months when temperature and humidity are high. This review presents a comprehensive list of heat illnesses with a focus on sideline treatments and prevention of heat illness for the team medical staff.
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PMID:Heat-related illness in athletes. 1760 28

Food borne botulism is a relatively rare clinical syndrome, which symptomatology is generally highly distinctive. The physicians of various specialties should be familiar with the symptoms of botulism because its sings concern the nervous system, the organ of sight and the gastrointestinal system. In older persons with coexisting chronic diseases some symptoms of botulism may be not distinctive or may mimic exacerbation of early existing diseases. The handbook descriptions present the food borne botulism as dramatic and often deadly disease. However in some cases this disease can have mild course and poor symptomatology. Two cases of food borne botulism with different clinical course are presented in this paper, when the correct diagnosis was established with delay. A 78-year-old man was admitted with the symptoms of pneumonia and dizziness of uncertain aetiology. The diagnosis of food borne botulism was established in 10th day of hospital stay, when the most symptoms were not present. Despite of such late diagnosis and relatively good patient's condition a therapy with antitoxin was administrated. The second case reports a 70-year-old man with chronic heart failure, diabetes and obesity, when the delay of correct diagnosis was about of 24 hours. Despite of relatively early antitoxin administration and intensive supportive care patient died in 11th day of hospital stay.
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PMID:[Diagnostic difficulties in foodborne botulism--case reports and literature review]. 1772 10

To assess the associations between job stress and somatic symptoms and to investigate the effect of individual coping on these associations. In July 2006, a cross-sectional study was conducted during a periodic health check-up of 185 Japanese male office workers (21-66 yr old) at a Japanese company. Job stress was measured by job demand, control, and strain (=job demand/control) based on the Job Content Questionnaire (JCQ). Major somatic symptoms studied were headache, dizziness, shoulder stiffness, back pain, shortness of breath, abdominal pain, general fatigue, sleep disturbance, and skin itching. Five kinds of coping were measured using the Job Stress Scale: active coping, escape, support seeking, reconciliation, and emotional suppression. Comorbidities of hypertension, diabetes, obesity, depression, and anxiety were also evaluated. The most frequently cited somatic symptom was general fatigue (66%), followed by shoulder stiffness (63%) and sleep disturbance (53%). Of the five kinds of coping, only "active coping" was significantly and negatively associated with the number of somatic symptoms. The generalized linear models showed that the number of somatic symptoms increased as job strain index (p=0.001) and job demand (p=0.001) became higher, and decreased as active coping (p=0.018) increased, after adjusting for age and comorbidities. There was no statistical interaction among active coping, the number of somatic symptoms, and the three JCQ scales. Reporting somatic symptoms may be a simple indicator of job stress, and active coping could be used to alleviate somatization induced by job stress.
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PMID:The association of the reporting of somatic symptoms with job stress and active coping among Japanese white-collar workers. 1795 68

A post hoc pooled analysis of 2 multicenter, randomized, double-blind, active-controlled force-titration studies assessed the antihypertensive efficacy and tolerability of 7 to 8 weeks' once-daily fixed-dose irbesartan/hydrochlorothiazide (HCTZ) 300/25 mg in 796 stage 1 or 2 hypertensive patients according to age (65 years or older or younger than 65) (n=121 or 675) and presence or absence of obesity (n=378 or 414), type 2 diabetes (n=99 or 697), and high World Health Organization-defined cardiovascular risk (n=593 or 202). Systolic/diastolic blood pressure reductions (27-31/16-22 mm Hg) were similar regardless of age, obesity, and type 2 diabetes status and were greater in high- vs low-risk patients. Dizziness (2.0%-3.7%), hypotension (0%-0.7%), and syncope (0%) were rare and not centered in any subgroup. There was no hypotension in the elderly or in type 2 diabetics. Irbesartan/HCTZ provided consistent blood pressure lowering and tolerability regardless of age, obesity, and type 2 diabetes and greater efficacy in patients with high cardiovascular risk.
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PMID:The efficacy and safety of initial use of irbesartan/hydrochlorothiazide fixed-dose combination in hypertensive patients with and without high cardiovascular risk. 1804 9

Taranabant is a novel cannabinoid CB-1 receptor (CB1R) inverse agonist in clinical development for the treatment of obesity. This double-blind, randomized, placebo-controlled, single oral dose study evaluated the safety, tolerability, pharmacokinetics, and pharmacodynamics of taranabant (0.5-600 mg) in 24 healthy male volunteers. Single-dose AUC(0-infinity) and C(max) values for taranabant increased approximately linearly with dose up to 200 mg, with slightly less than dose-proportional increases in AUC(0-infinity) and C(max) values for doses >200 mg. Plasma taranabant had a biphasic disposition, with a median t(max) of 1 to 2.5 hours and a terminal elimination t((1/2)) of 38 to 69 hours. Coadministration of taranabant with a high-fat meal led to a 14% increase in C(max) and a 74% increase in AUC(0-infinity). Clinical adverse experiences associated with single doses of taranabant were generally mild and transient. Of the 198 clinical adverse experiences reported, the most common drug-related ones were nausea (36), headache (22), drowsiness (14), abdominal discomfort/abdominal pain/stomachache (14), hiccups (9), dizziness (8), decreased appetite (7), increased bowel movement (7), mood change (6), tiredness (4), vomiting (4), and sweating increased (4). Taranabant has pharmacokinetic characteristics suitable for a once-daily dosing regimen.
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PMID:Safety, tolerability, pharmacokinetics, and pharmacodynamic properties of taranabant, a novel selective cannabinoid-1 receptor inverse agonist, for the treatment of obesity: results from a double-blind, placebo-controlled, single oral dose study in healthy volunteers. 1825 50

Rimonabant is a novel drug for treatment of obesity. Four randomised studies have shown a significant effect of 20 mg rimonabant on bodyweight and other cardiovascular risk factors. The weight loss is modest, approximately 5 %, and the patients regain their baseline weight within 9 months after withdrawal. There is no evidence that rimonabant reduces morbidity or mortality, and no comparative studies with orlistat or sibutramine have been performed. Long-term effects of blocking the endocannabinoid system are not known. Side effects are nausea, depressive symptoms, anxiety and dizziness. There are reports on increased suicidality, and rimonabant is contraindicated in depressed patients.
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PMID:[The endocannabinoid system and treatment of obesity]. 1831 Dec 1

Rimonabant, the first selective CB(1) receptor antagonist in clinical use, has been extensively investigated in the Rimonabant in Obesity (RIO) programme, comprising four 1-2 year placebo-controlled randomised clinical trials recruiting more than 6600 overweight/obese patients with or without co-morbidities. Rimonabant 20 mg daily consistently reduced body weight, waist circumference, triglycerides, blood pressure, insulin resistance and C-reactive protein levels, and increased HDL cholesterol concentrations in both non-diabetic and type-2 diabetic overweight/obese patients. Adiponectin levels were increased, an effect that correlated with HDL cholesterol augmentation, while small dense LDL cholesterol levels were decreased in patients receiving rimonabant 20 mg compared with those receiving placebo in RIO Lipids. Furthermore, in RIO Diabetes, a 0.7% reduction in glycated haemoglobin (HbA1c) levels was observed in metformin- or sulphonylurea-treated patients with type-2 diabetes, an effect recently confirmed in the 6-month SERENADE (Study Evaluating Rimonabant Efficacy in drug-NAive DiabEtic patients) trial in drug-naive diabetic patients. Almost half of metabolic changes occurred beyond weight loss, in agreement with direct peripheral effects. The positive effects observed after 1 year were maintained after 2 years. Rimonabant was generally well-tolerated, but with a slightly higher incidence of depressed mood disorders, anxiety, nausea and dizziness compared with placebo. In clinical practice, rimonabant has to be prescribed to the right patient, i.e. overweight/obese subjects with cardiometabolic risk factors and with no major depressive illness and/or ongoing antidepressive treatment, in order to both maximise efficacy and minimise safety issues. New trials are supposed to confirm the potential role of rimonabant in patients with abdominal adiposity, atherogenic dyslipidaemia and/or type-2 diabetes, i.e. at high cardiometabolic risk.
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PMID:CB1 receptor blockade and its impact on cardiometabolic risk factors: overview of the RIO programme with rimonabant. 1842 13

Lorcaserin (APD356) is a potent, selective 5-HT(2C) agonist with ~15-fold and 100-fold selectivity vs. 5-HT(2A) and 5-HT(2B) receptors, respectively. This study evaluated the safety and efficacy of lorcaserin for weight reduction in obese patients during a 12-week period. The randomized, double-blind, placebo-controlled, parallel-arm study enrolled 469 men and women between ages 18 and 65 and with BMI 30-45 kg/m(2). Patients received placebo, lorcaserin 10 mg q.d., lorcaserin 15 mg q.d., or lorcaserin 10 mg b.i.d. for 12 weeks, and were counseled to maintain their usual diet and activity. The primary end point was change in weight from baseline to day 85 by completer analysis. Safety analyses included echocardiograms at Screening and day 85/study exit. Lorcaserin was associated with progressive weight loss of 1.8 kg, 2.6 kg, and 3.6 kg at 10 mg q.d., 15 mg q.d., and 10 mg b.i.d., respectively, compared to placebo weight loss of 0.3 kg (P < 0.001 for each group). Similar results were seen by intent-to-treat last observation-carried forward (ITT-LOCF) analysis. The proportions of completers achieving > or =5% of initial body weight were 12.8, 19.5, 31.2, and 2.3% in the 10 mg q.d., 15 mg q.d., 10 mg b.i.d., and placebo groups, respectively. The most frequent adverse events (AEs) were transient headache, nausea, and dizziness. Echocardiograms showed no apparent drug-related effects on heart valves or pulmonary artery pressure (PAP). Lorcaserin was well tolerated and efficacious for weight reduction in this 12-week study. Longer-term trials employing behavior modification will be needed to more fully assess its safety and efficacy.
Obesity (Silver Spring) 2009 Mar
PMID:Lorcaserin (APD356), a selective 5-HT(2C) agonist, reduces body weight in obese men and women. 1905 23

Atypical antipsychotic medications like olanzapine (OLZ) induce weight gain and increase the risk of diabetes in patients with schizophrenia. The goal of this study was to assess potential mechanisms of OLZ-induced weight gain and accompanying metabolic effects. Healthy, lean, male volunteers received OLZ and placebo (PBO) in a randomized, double-blind, crossover study. In periods 1 and 2, subjects received OLZ (5 mg for 3 days then OLZ 10 mg for 12 days) or matching PBO separated by a minimum 12-day washout. Twenty-four hour food intake (FI), resting energy expenditure (REE), activity level, metabolic markers, and insulin sensitivity (IS) were assessed. In total, 30 subjects were enrolled and 21 completed both periods. Mean age and BMI were 27 years (range: 18-49 years) and 22.6 +/- 2.2 kg/m(2), respectively. Relative to PBO, OLZ resulted in a 2.62 vs. 0.08 kg increase in body weight (P < 0.001) and 18% (P = 0.052 or 345 kcal) increase in FI. Excluding one subject with nausea and dizziness on the day of OLZ FI measurement, the increase in FI was 547 kcal, (P < 0.05). OLZ increased REE relative to PBO (113 kcal/day, P = 0.003). Significant increases in triglycerides, plasminogen activator inhibitor-I (PAI-I), leptin, and tumor necrosis factor-alpha (TNF-alpha) were observed. No significant differences in activity level or IS were observed. This study provides evidence that OLZ pharmacology drives the early increase in weight through increased FI, without evidence of decreased energy expenditure (EE), activity level, or short-term perturbations in IS.
Obesity (Silver Spring) 2010 Aug
PMID:Increased food intake and energy expenditure following administration of olanzapine to healthy men. 2013 8

Exercise therapy is generally recommended in osteoarthritis (OA) of the hip or knee. However, coexisting disorders may bring additional impairments, which may necessitate adaptations to exercise for OA of the hip or knee. For the purpose of developing an adapted protocol for exercise therapy in OA patients with coexisting disorders, information is needed on which specific coexisting disorders in OA are associated with activity limitations and pain. To describe the relationship between specific coexisting disorders, activity limitations, and pain in patients with OA of the hip or knee, a cross-sectional cohort study among 288 older adults (50-85 years of age) with OA of hip or knee was conducted. Subjects were recruited from three rehabilitation centers and two hospitals. Demographic data, clinical data, information about coexisting disorders (i.e., comorbidity and other disorders), activity limitations (WOMAC: physical functioning domain), and pain (visual analogue scale (VAS)) were collected by questionnaire. Statistical analysis included descriptive statistics and multivariate regression analysis. Coexisting disorders associated with activity limitations were chronic back pain or hernia, arthritis of the hand or feet, and other chronic rheumatic diseases (all musculoskeletal disorders); diabetes and chronic cystitis (non-musculoskeletal disorders); hearing impairments in a face-to-face conversation, vision impairments in long distances, and dizziness in combination with falling (all sensory impairments); and overweight and obesity. Coexistent disorders associated with pain were arthritis of the hand or feet, other chronic rheumatic diseases (musculoskeletal disorders), and diabetes (non-musculoskeletal disorder). Specific disorders coexisting next to OA and associated with additional activity limitations and pain were identified. These coexisting disorders need to be addressed in exercise therapy and rehabilitation for patients with OA of the hip or knee.
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PMID:Osteoarthritis of the hip or knee: which coexisting disorders are disabling? 2017 25


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